Association between serum homocysteine and sarcopenia among hospitalized older Chinese adults: a cross-sectional study

Abstract

Objective Hyperhomocysteinemia (HHcy) is considered to increase the risk of sarcopenia (S) and remains controversial. In this study, we aimed to investigate the prevalence of S among older Chinese adults and explore whether homocysteine (Hcy) was independently associated with S. Methods This cross-sectional study was performed among older adults hospitalized in the Geriatric Hospital of Nanjing Medical University between June 2017 and December 2021. We measured all participants’ serum Hcy levels, hand grip strength, gait speed and appendicular skeletal muscle index(ASMI) using bioelectrical impedance analysis (BIA). S was defined based on the criteria of the Asian Working Group for Sarcopenia 2 (AWGS2), which included muscle mass (ASMI< 7.0 kg/m2 for men and ASMI< 5.7 kg/m2 for women by BIA) and low muscle strength (handgrip strength < 28 kg for men and < 18 kg for women), and/or gait speed < 1.0 m/s. HHcy defined as Hcy ≥10 μmol/L. The strength of the association between Hcy and the risk of S was analyzed by multivariate logistic regression using three models that adjusted for possible confounding variables to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Results Among the 441 subjects, 161 (36.5%) were diagnosed with S, and 343 (77.8%) were diagnosed with HHcy. A significant association was detected between S and serum Hcy per 1-μmol/L increase after adjustment for age, gender, education, smoking, body mass index (BMI), Mini Nutritional Assessment Short Form (MNA-SF), alanine aminotransferase (ALT), C-reactive protein (CRP), hemoglobin (Hb), albumin (ALB), diabetes, kidney disease, and statin use (OR = 1.07, 95% CI = 1.03–1.12, P = 0.002). The OR for S in the HHcy group (≥10 μmol/L) was nearly 5-fold that in the normal Hcy group (OR 4.96, 95% CI 2.67–9.24, P < 0.001). In a gender-based subgroup analysis that adjusted for age, education, smoking, BMI, MNA-SF, ALT, CRP, Hb, and ALB, female subjects with HHcy had an increased risk of S (OR 10.35, 95% CI 2.84–37.68, P < 0.001). Conclusions Our results demonstrated that elevated Hcy levels have an independent association with S in older adults. This suggests that the downward adjustment of HHcy (cutoff value < 10 μmol/l) might decrease the risk of S.

Cholesterol-lowering medications and sarcopenia: Large cross- sectional Study ：NHANES 2011-2014

“…This study, which followed participants for an average period of 4.4 years, found no difference in grip strength decline between those who took statin cholesterol-lowering medication and those who did not. This indicates that long-term use of cholesterol-lowering medication does not seem to affect muscle strength in relation to sarcopenia [8].Furthermore, a cross-sectional study conducted in China among 441 elderly hospitalized patients also reported no statistically signi cant difference in cholesterol-lowering medication use between the sarcopenia and non-sarcopenia groups [9]. Similarly, an observational cohort study on 756 community-dwelling male veterans aged 65 and above found no difference in muscle strength testing between long-term users of statin medication and non-users [21].…”

“…Speci cally, the association between CLM and sarcopenia has garnered attention and remains a topic of contention. While the majority of studies suggest that these medications do not have a detrimental effect on skeletal muscle function, as symptoms associated with medication use typically resolve upon discontinuation [8,9], there is evidence indicating that CLM may have discernible effects on muscle function, potentially exacerbating the risk of developing sarcopenia to varying degrees [10,11]. However, a minority of studies present opposing viewpoints, suggesting that these medications not only do not negatively impact muscle function but may even offer protection to skeletal muscle to some extent [12,13].…”